The permanent thoracic drainage tubeRocket Indwelling Pleural Catheter – IPCis a silicone catheter, whose inner end is placed in the pleural cavity and outside tip, after having traveled a small subcutaneous route of few centimeters, exits through small skin bore and connected to a specific collection bag .

Main indication of system installation Rocket Indwelling Pleural Catheter – IPC are recurrent, malignant pleural effusion and trapped lung. The surgical technique of placing the Rocket Indwelling Pleural Catheter – IPC is short and is performed under local anaesthesia.

Description of technique

Connecting a patient to non-invasive cardiopulmonary monitoring. Sterilization of surgical field with povidone iodide solution and coating of adjacent area with aseptic monitors. Local infiltration of the area with anaesthetic d/ma and monitoring of anaesthesia adequacy. Diagnostic thoracentesis of the mediastinum with a 22G needle. If the thoracentesis is positive for fluid, proceed with a small skin and subcutaneous incision with a No. 11 blade in the thoracentesis area. Thoracentesis of the hemithorax and insertion of a guide wire into the pleural cavity (Seldinger technique). Local infiltration of a preselected adjacent area of the subcutaneous tube with anaesthetic d/ma and check for adequacy of anaesthesia. Small skin incision in the selected skin exit area of the tube with a N-blade^ο11. Preparation of a substrate and creation of a tunnel substrate connecting the two holes. Insertion of the tube into the subcutaneous tunnel. Slight widening of the first skin incision with a knife N^o11. Insert expander into wire guide and remove expander. Inserting a sheath into the wire guide and removing the wire guide. Then gradually insert the end of the tube through the sheath into the pleural cavity and at the same time gradually remove the sheath. Check that the tube is running smoothly and that the tube is stable. Closure of the two small wounds with individual Prolene N^o 3-0. Sterilization of the surgical field with povidone iodide solution. Connect the free end of the drainage tube to the special plastic collection bag. Coating of the surgical wound with dressing material. Transferring the patient to his bed and ordering a chest X-ray.

Instructions after installation

Imaging assessment

• Directly by chest X-ray (F+P)
• The morning of the next day with a chest X-ray (F+P)

Relevant medication and other treatment recommendations

• Broad-spectrum antibiotic treatment (e.g. tb cefuroxime 500mg 1X2 pos for 5 days)
• Analgesic treatment with a combination of non-steroidal, anti-inflammatory with mild opioids and simple analgesics (e.g. tb etoricoxib 60mg 1X1 pos, tb paracetamol 500mg - codeine 30mg 1X3 pos)
• Gastroprostacy (e.g. tb ranitidine 100mg 1X2 pos)
• Bronchodilator treatment (e.g. amp ipratropium-salbutamol + amp budesonide 1X4 neb)
• Mucolytic treatment (e.g. sachet acetylcysteine 600mg 1X2 pos)
• Wound re-examination and heparinization in two (2) days
• Daily wound care (antisepsis and dressing change) for five (5) days
• Suture removal in ten (10) days
• If an unexpected change is observed in the wound area (e.g. bleeding, redness, swelling, burning pain) or swelling of the corresponding upper limb, it is necessary to contact the attending physician.
• Satisfactory hydration
• Periodic monitoring of serum albumin levels in the blood and the administration of a hyperleukemic diet accordingly
• Respiratory physiotherapy (+ respiratory exercise instrument) and mobilisation
• Patient and family education on changing the collection bag
• Reassessment by a specialist Thoracic Surgeon